Dialysis disequilibrium syndrome (DDS) is a condition that arises following hemodialysis, typically in patients undergoing hemodialysis for the first time or in patients with risk factors including elevated blood urea nitrogen prior to hemodialysis, chronic kidney disease, severe metabolic acidosis, and other disorders that cause cerebral edema or increase the permeability of the blood-brain barrier. It is more common in older adults and children.

DDS occurs due to osmotic shifts and rapid lowering of urea and plasma osmolality, resulting in the development of cerebral edema following hemodialysis. Patients present with symptoms including headache, nausea, vomiting, muscle cramps, tremor, confusion, and convulsions. Symptoms typically present during or immediately following hemodialysis or early in the course of continuous renal replacement therapy. DDS has not been described with continuous peritoneal dialysis.

Treatment involves slowing the blood flow rate of dialysis or cessation of dialysis in severe cases.